Peroperative treatment with i.v. ketoprofen reduces pain and vomiting in children after strabismus surgery

Abstract

Background: Strabismus surgery is associated with both pain and vomiting. Ketoprofen is widely used in adults to treat acute pain, but there are only few reports of its use in children. This randomised, double-blind, placebo-controlled, parallel group study was designed to investigate the analgesic effect of i.v. ketoprofen and its effect on the incidence of vomiting in children after day-case strabismus surgery. Methods: Fifty-nine ASA 1 children, aged 1-12 years, entered the study. After premedication with diazepam and glycopyrronium, anaesthesia was induced with fentanyl and propofol and maintained with isoflurane. After induction the children in the ketoprofen group received 1 mg kg-1 ketoprofen followed by an infusion of 1 mg kg-1 ketoprofen over 2 h. In the placebo group, children received 0.9% saline. The postoperative pain was assessed by the Maunuksela pain score (0=no pain, 10= worst possible pain). All children received fentanyl as a rescue analgesic if the Maunuksela score was ≥3. Results: In the ketoprofen group the number of fentanyl doses was smaller compared to the placebo group (median 1, quartiles (0-2) vs. 2 (1-3), P=0.047). The children in the ketoprofen group had less pain at 30 min (P=0.02) and the worst pain observed in the post anaesthesia care unit was lower (3 (0-6) vs. 5 (3-8), P=0.035). The incidence of vomiting was less in the ketoprofen group compared to the placebo group (17% vs. 41%, P=0.036). No serious adverse reactions occurred. Conclusion: We concluded that ketoprofen administered i.v. during the operation produced analgesia and reduced opioid consumption and the incidence of vomiting in children after strabismus surgery.